Active NPI
Joshua Dejesus
- Behavior Technician
- Dade City, FL
National Provider Identifier
1457135717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-23-292080
- Practice address
- 13424 Fort King Rd
Dade City, FL 33525-5214 - Phone
- (352) 584-2627
- NPI assigned
- Aug 18, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-23-292080 | FL | Primary |
Addresses
Primary practice location
13424 Fort King Rd
Dade City, FL 33525-5214
Mailing address
620 69TH Ave W
Bradenton, FL 34207-6165
Phone (786) 508-7588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-23-292080 | FL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luminescence Therapy LLC | Current | Accepting new patients |
Locations
13424 Fort King Rd
Dade City, FL 33525
Phone (352) 347-3559
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Dade City, FL
- NPI 1700508041
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692316800000",
"number": "1457135717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 69TH AVE W",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342076165",
"telephone_number": "786-508-7588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13424 FORT KING RD",
"city": "DADE CITY",
"state": "FL",
"postal_code": "335255214",
"telephone_number": "352-584-2627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEJESUS",
"first_name": "JOSHUA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-18",
"last_updated": "2023-08-18",
"certification_date": "2023-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-23-292080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dade City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.